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| 不同容积布比卡因腹横肌平面阻滞用于腹股沟斜疝患儿术后镇痛的效果 |
| Comparison of transversus abdominis plane block with different volumes of bupivacaine for pain management in children undergoing inguinal hernia repair |
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| DOI：10.12089/jca.2019.08.015 |
| 中文关键词: 腹横肌平面阻滞 布比卡因 容积 腹股沟疝修补 患儿 |
| 英文关键词: Transversus abdominis plane block Bupivacaine Volume Inguinal hernia repair Preschool childeren |
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| 中文摘要: |
目的 探讨使用相同浓度不同容积的布比卡因行腹横肌平面阻滞对患儿腹股沟斜疝患儿术后镇痛作用的影响。
方法 择期行腹股沟斜疝修补术的患儿120例，男95例，女25例，年龄1~6岁，体重8.3~26.5 kg，ASA Ⅰ级。随机分为四组，三组使用浓度为0.15%的布比卡因，按不同容积分为0.4 ml/kg组（V4组）、0.5 ml/kg组（V5组）、0.6 ml/kg组（V6组）；一组使用2%的利多卡因进行局部浸润麻醉（V0组）。采用儿童疼痛行为量表评估术后即刻(T0)和术后1 h(T1)、2 h(T2)、6 h(T3)的疼痛程度。当儿童疼痛行为量表评分>5分时，静脉注射芬太尼0.25 μg/kg补救镇痛。记录术后1 h追加芬太尼的例数。
结果 与V6组比较，T2—T3时V4、V5、V0组儿童疼痛行为量表评分明显升高（P<0.05）；与T0时比较，T2—T3时V4、V5、V0组儿童疼痛行为量表评分明显增高（P<0.05），T3时V6组儿童疼痛行为量表评分明显增高（P<0.05）。与V0组比较，V6组术后1 h内追加芬太尼的例数明显减少（P<0.05）。
结论 儿童患者腹股沟疝修补术使用0.15%布比卡因行TAPB时，在有效剂量和安全剂量范围内，布比卡因的容积更大，术后1 h内镇痛不足的比例减少，术后6 h内镇痛作用持续时间较长，镇痛效果更好。 |
| 英文摘要: |
Objective To investigate the effect of different bupivacaine volumes in equal concentration on postsurgical analgesia in children receiving transversus abdominis plane block (TAPB) following inguinal hernia repair.
Methods One hundred and twenty pediatric patients scheduled for inguinal hernia repair, 95 males and 25 females, aged 1-6 years, weighing 8.3-26.5 kg，ASA physical status Ⅰ, were randomized to one of 4 equal groups: three groups received TAPB with different volumes of 0.15% bupivacaine: 0.4 ml/kg (group V4), 0.5 ml/kg (group V5), 0.6 ml/kg (group V6), and one group received local anesthetic infiltration with 2% lidocaine (group V0). Pain was assessed using the face, legs, activity, cry, consolability (FLACC) scale at 0, 1, 2 h and 6 h postoperatively. Fentanyl 0.25 μg/kg was injected intravenously as rescue analgesic when FLACC score > 5.
Results The FLACC score of group V6 was higher than that of groups V4, V5 and V0 (P < 0.05). Compare with T0, FLACC score of groups V4,V5 and V0 in T2, T3 are significantly higher(P < 0.05), FLACC score of group V6 in T3 is significantly higher (P < 0.05). Compared with group V0, the number of add fentanyl cases within 1 h after operation is significantly lower (P < 0.05)．
Conclusion In children with inguinal hernia repair, when 0.15% bupivacaine is used for TAPB, the volume of bupivacaine is larger in the effective dose and safe dose range, and the proportion of analgesia is reduced within 1 hour after surgery. The analgesic effect lasted for 6 hours and the analgesic effect was better. |
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